Women and Heart Diseases

Cardiovascular disease (CVD) is the leading cause of mortality among women accounting for the death of one-third of all women globally. Although age-standardized cardiovascular mortality has declined in women, it is still mainly observed in high-income countries with little change or worsening in lower income regions including India. Women have a unique risk factor profile, with several CVD risk factors that are unique to women including pregnancy-associated conditions that increase the risk of CVD such as preeclampsia and other hypertensive disorders of pregnancy, preterm birth, pregnancy loss, and gestational diabetes, as well as other conditions such as polycystic ovarian syndrome and premature menopause. It is well known that social determinants of health impact future cardiovascular health, but poverty, education, and social deprivation particularly affect women. This places women at a particular risk in lower income countries. Not only does the unique risk factor profile of women and the enhanced impact of the social determinants of health contribute to the augmented risk of CVD in women, but also the effects of prevalent CVD are greater. Women with CVD consistently have worse outcomes than men. Women are less likely to be referred for specialist services for treatment and less likely to have guideline recommended care and access to newer technologies and have worse morbidity and mortality outcomes. While some have argued that this may relate in part to biology, it is clear that structural and overt sexism in our healthcare systems have a greater role in contributing to these inequalities. It is important to highlight that nearly 75% of coronary heart disease cases in women can be prevented—we as a community of physicians have to do better.

It is within this context that Women In Cardiology And Related Sciences (WINCARS) Association was founded, a signature initiative from women cardiologists which serves as a catalyst to bring a change in the cardiovascular heath of women in India—both in raising awareness of the impact of CVD in women and in overcoming barriers faced by women in medicine professionally. This book “Women and Heart Diseases” represents an important resource for women’s cardiovascular health. Its 21 chapters cover nontraditional risk factors for women including pregnancy-related disorders, autoimmune conditions, and social and behavioral factors that are known to be important determinants of future CVD, alongside more traditional risk factors such as hypertension. The intersection between CVD and cancer is covered, particularly in the case of breast cancer with further chapters focused around cardiac imaging, atrial fibrillation, and peripheral vascular disease. Other chapters focus around coronary artery disease and INOCA, which predominantly impact women, providing insights into diagnoses, treatments, and longer term outcomes as well as spontaneous coronary artery dissection that predominantly affects younger women and accounts for 25% of myocardial infarction in women under the age of 60 years. Inequalities in the receipt of treatments and outcomes are a recurring theme, with chapters highlighting heart failure, stroke, and PCI as exemplars of acute cardiovascular conditions with a specific focus around the primary and secondary prevention of CVD and drug therapy.

Women and Heart Diseases is a comprehensive academic resource dedicated to understanding cardiovascular disease (CVD) in women. With CVD being the leading cause of mortality among women globally, this book highlights the unique risk factors that women face, including pregnancy-related

conditions, autoimmune disorders, and social determinants of health.The book, comprising 21 chapters, covers non-traditional risk factors, disparities in treatment access, and the intersection between CVD and other conditions like breast cancer. It also delves into critical areas such as coronary artery disease, spontaneous coronary artery dissection, and heart failure.Women and Heart Diseases serves as an essential reference for physicians and researchers, advocating for better prevention, management, and equitable healthcare for women. The initiative is supported by WINCARS, a pioneering association aimed at improving cardiovascular health outcomes for women in India and beyond.